What is the fee schedule?
Your practice keeps a fee schedule in Athena: the list of billing codes with fees set for each department and insurance. CarePilot reads that fee schedule so the billing codes it shows you for a visit are ones your practice has a fee for.
For each visit, CarePilot looks at two things:
The visit's department
The patient's primary insurance
CarePilot then checks which codes in its billing code catalog have an Athena fee for that department and insurance. Those are the codes you'll see in Billing, whether you search for a code yourself or AI suggests one.
A few things to know:
It updates automatically. CarePilot keeps billing choices in sync with your Athena fee schedule. Neither admins nor providers need to refresh anything in CarePilot.
CarePilot reads your fee schedule. It does not change it. To add or change a fee, do it in Athena.
Codes with a $0 fee are included. A code only needs to have a fee entry in Athena to show up.
You aren't limited to common codes. Search covers CarePilot's full code catalog, so less common codes appear if your practice has a fee for them.
A fee-backed code isn't a guarantee. Athena can still reject a service for other reasons. CarePilot shows you the result for each item after you send (see After you send to EHR).
For practice admins
There's nothing to set up or maintain in CarePilot. CarePilot reads your Athena fee schedule and updates billing choices automatically, getting upcoming visits ready ahead of time.
Your only task is keeping your Athena fee schedule complete. If providers can't find a code they need, check that the code has a fee in Athena for that department and insurance. Once you add it in Athena, CarePilot picks it up automatically.
Good to know
Fee changes don't affect billing that's already saved. Items providers already added to a visit stay as they are, and a fee change alone won't stop them from being sent.
Choices don't disappear if an update has trouble. If CarePilot can't finish an update, providers keep using the last complete set of billing choices.
For providers
What you'll see in Billing
When you open Billing for a visit, you'll see the visit's primary insurance. CarePilot always uses primary insurance for billing choices, even when the patient has secondary insurance. There's no option to switch to another policy.
If the visit's billing choices aren't ready yet, you'll see a progress indicator while CarePilot checks current fees in Athena. This usually takes a moment.
Find and add a billing code
In Billing, search by code or description.
Each result shows both the code and its description.
Select a code to add it. It saves right away with no extra form.
New items you add:
Start with a quantity of 1 (you can change it).
Count as approved by you, so you don't need to click Accept.
Have no source label, since you added them yourself.
If a code is already in the visit, it appears greyed out in search with the message
"This code is already in the visit." To bill more units of that code, increase the quantity on the existing item.
You can add billing before or after AI generates a note, including while pre-charting.
AI billing suggestions
AI suggests billing from the same fee-backed codes you see in search. If AI suggests a code that's already on the visit, it updates that item instead of adding a duplicate.
Messages you might see
Message or situation | What it means | What to do |
Progress indicator when opening Billing | CarePilot is checking current Athena fees for this visit. | Wait a moment for choices to load. |
Billing choices are unavailable; the visit's insurance needs attention | The visit has no primary insurance, so CarePilot can't tell which codes are fee-backed. Code search and Add billing item are turned off, and AI won't add billing. | Add or correct primary insurance on the appointment in Athena. |
No fee-backed choices are available | None of the codes has an Athena fee for this department and insurance. | Ask your practice admin to check the Athena fee schedule for this department and insurance. |
Choices are unavailable | CarePilot couldn't finish checking fees. To avoid unverified codes, it won't show any. | Contact CarePilot Support. |
No matching codes | Nothing matches your search. | Try another code or description. If the code should be there, see the next section. |
Search error notification | The search didn't go through. | Select Try again. |
Already-saved billing is safe. If choices become unavailable or fees change, billing items you've already saved, along with your edits, stay as they are.
A code I need isn't showing up
If a code you expect is missing from search, it's usually one of these:
The practice doesn't have a fee for it in Athena for this visit's department and primary insurance. → Ask your practice admin to add the fee in Athena. CarePilot picks it up automatically.
The visit has the wrong primary insurance or department. → Correct the appointment in Athena.
The code isn't in CarePilot's code catalog yet, for example a newly released code. → Contact CarePilot Support or your Customer Success Manager with the code.
After you send to EHR
Approving an item isn't the same as Athena accepting it. After you select Send to EHR, each item shows its own result, and that result stays on the visit:
Status | Meaning |
Sent to EHR | Athena confirmed it created the service. |
Rejected by Athena | Athena rejected the item, even though you approved it. |
Couldn't send | CarePilot couldn't send the item. Open it to see the reason. |
Delivery unconfirmed | CarePilot couldn't confirm whether Athena received it. |
For anything other than Sent to EHR, check the item in Athena.
FAQ
Do I need to update the fee schedule in CarePilot? No. CarePilot updates automatically from Athena. If a fee is missing, add it in Athena.
Can I edit fees in CarePilot? No. CarePilot only reads your Athena fee schedule.
Why does CarePilot use only primary insurance? Billing choices are based on the primary payer. Secondary insurance isn't used to decide which codes are available.
Will a fee change affect visits that are already billed? No. Saved and sent billing stays as it is.
Why is a $0 code showing up? Any code with a fee entry in Athena counts as fee-backed, including $0 fees.
Need help? Contact CarePilot Support or your Customer Success Manager.